cobra notice - California`s Valued Trust

Second qualifying event extension of 18-month period of continuation coverage
“To protect your
family’s rights, let
CVT know about
any changes in the
addresses of family
members “
If your family experiences another qualifying event during the 18 months of COBRA
continuation coverage, the spouse and dependent children in your family can get up to
18 additional months of COBRA continuation coverage, for a maximum of 36 months, if
CVT is properly notified in writing about the second qualifying event. This extension may
be available to the spouse and any dependent children getting COBRA continuation
coverage if the employee or former employee dies; becomes entitled to Medicare
benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the
dependent child stops being eligible under the Plan as a dependent child. This extension
is only available if the second qualifying event would have caused the spouse or
dependent child to lose coverage under the Plan had the first qualifying event not
occurred.
Are there other coverage options besides COBRA Continuation
Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage
options for you and your family through the Health Insurance Marketplace, Medicaid, or
other group health plan coverage options (such as a spouse’s plan) through what is called
a “special enrollment period.” Some of these options may cost less than COBRA
continuation coverage. You can learn more about many of these options at
www.healthcare.gov.
“This notice
If you have questions
explains COBRA
Questions concerning your Plan or your COBRA continuation coverage rights should be
addressed to the contact or contacts identified below. For more information about your
rights under the Public Health Services Act (PHSA) contact the Department of Health and
Human Services in your area or visit www.healthcare.gov/unemployed/cobra-coverage.
For more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
PHONE: 559.437.2960
FA X : 5 5 9 . 4 3 7 . 2 9 6 5
A D D R E S S : P. O . B o x 2 6 3 0 0
F r e s n o , C A 9 3 7 2 9
To protect your family’s rights, let CVT know about any changes in the addresses of family
members by emailing CVT at [email protected]. You should also keep a copy,
for your records, of any notices you send to CVT.
W E B S I T E : w w w. c v t r u s t . o r g
EMAIL: [email protected]
Plan contact information
California’s Valued Trust (CVT)
P.O. Box 26300
Follow us on Facebook!
Continuation
Coverage Rights
Under COBRA
Fresno, CA 93729-6300
559-437-2960
4
continuation
coverage, when it
may become
available to you and
your family, and
what you need to do
to protect your right
to get it. “
Introduction
You’re getting this notice because you recently gained coverage under a group
health plan (the Plan). This notice has important information about your right to
COBRA continuation coverage, which is a temporary extension of coverage under
the Plan. This notice explains COBRA continuation coverage, when it may
become available to you and your family, and what you need to do to protect
your right to get it. When you become eligible for COBRA, you may also become
eligible for other coverage options that may cost less than COBRA continuation
coverage.
The right to COBRA continuation coverage was created by a federal law, the
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA
continuation coverage can become available to you and other members of your
family when group health coverage would otherwise end. For more information
about your rights and obligations under the Plan and under federal law, you should
review the Plan’s Summary Plan Description at www.cvtrust.org/plan-documents or
call California’s Valued Trust (CVT) at 1-800-288-9870.
You may have other options available to you when you lose group health
coverage. For example, you may be eligible to buy an individual plan through the
Health Insurance Marketplace. By enrolling in coverage through the Marketplace,
you may qualify for lower costs on your monthly premiums and lower out-of-pocket
costs. Additionally, you may qualify for a 30-day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if
that plan generally doesn’t accept late enrollees.
1
What is COBRA continuation
coverage?
COBRA continuation coverage is a continuation
of Plan coverage when it would otherwise end
because of a life event. This is also called a
“qualifying event.” Specific qualifying events are
listed later in this notice. After a qualifying
event, COBRA continuation coverage must be
offered to each person who is a “qualified
beneficiary.” You, your spouse, and your dependent children could become qualified
beneficiaries if coverage under the Plan is lost because of the qualifying event.
Under the Plan, qualified beneficiaries who elect COBRA continuation coverage
must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage
under the Plan because of the following qualifying events:
•
•
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose
your coverage under the Plan because of the following qualifying events:
•
•
•
•
•
Your spouse dies;
Your spouse’s hours of employment are reduced;
Your spouse’s employment ends for any reason other than his or her gross
misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or
both); or
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage
under the Plan because of the following qualifying events:
•
•
•
•
•
•
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after
the Plan Administrator has been notified that a qualifying event has occurred. The
employer must notify the Plan Administrator of the following qualifying events:
•
•
•
The end of employment or reduction of hours of employment;
Death of the employee; or
The employee’s becoming entitled to Medicare benefits (under Part A, Part B,
or both).
For all other qualifying events (divorce or legal separation of the employee and
spouse or a dependent child’s losing eligibility for coverage as a dependent
child), you must notify CVT in writing within 60 days after the qualifying event
occurs. You must provide this notice to:
California’s Valued Trust (CVT)
P.O. Box 26300
Fresno, CA 93729-6300
How is COBRA continuation coverage provided?
Once CVT receives written notice that a qualifying event has occurred, COBRA
continuation coverage will be offered to each of the qualified beneficiaries. Each
qualified beneficiary will have an independent right to elect COBRA continuation
coverage. Covered employees may elect COBRA continuation coverage on behalf of
their spouses, and parents may elect COBRA continuation coverage on behalf of their
children.
COBRA continuation coverage is a temporary continuation of coverage that generally
lasts for 18 months due to employment termination or reduction of hours of work.
Certain qualifying events, or a second qualifying event during the initial period of
coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage
can be extended:
The parent-employee dies;
The parent-employee’s hours of employment are reduced;
The parent-employee’s employment ends for any reason other than his or
her gross misconduct;
The parent-employee becomes entitled to Medicare benefits (Part A, Part B,
or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent
child.”
2
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security
to be disabled and you notify CVT in writing in a timely fashion, you and your entire
family may be entitled to get up to an additional 11 months of COBRA continuation
coverage, for a maximum of 29 months. The disability would have to have started at
some time before the 60th day of COBRA continuation coverage and must last at least
until the end of the 18-month period of COBRA continuation coverage.
3
What is COBRA continuation
coverage?
COBRA continuation coverage is a continuation
of Plan coverage when it would otherwise end
because of a life event. This is also called a
“qualifying event.” Specific qualifying events are
listed later in this notice. After a qualifying
event, COBRA continuation coverage must be
offered to each person who is a “qualified
beneficiary.” You, your spouse, and your dependent children could become qualified
beneficiaries if coverage under the Plan is lost because of the qualifying event.
Under the Plan, qualified beneficiaries who elect COBRA continuation coverage
must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage
under the Plan because of the following qualifying events:
•
•
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose
your coverage under the Plan because of the following qualifying events:
•
•
•
•
•
Your spouse dies;
Your spouse’s hours of employment are reduced;
Your spouse’s employment ends for any reason other than his or her gross
misconduct;
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or
both); or
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage
under the Plan because of the following qualifying events:
•
•
•
•
•
•
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after
the Plan Administrator has been notified that a qualifying event has occurred. The
employer must notify the Plan Administrator of the following qualifying events:
•
•
•
The end of employment or reduction of hours of employment;
Death of the employee; or
The employee’s becoming entitled to Medicare benefits (under Part A, Part B,
or both).
For all other qualifying events (divorce or legal separation of the employee and
spouse or a dependent child’s losing eligibility for coverage as a dependent
child), you must notify CVT in writing within 60 days after the qualifying event
occurs. You must provide this notice to:
California’s Valued Trust (CVT)
P.O. Box 26300
Fresno, CA 93729-6300
How is COBRA continuation coverage provided?
Once CVT receives written notice that a qualifying event has occurred, COBRA
continuation coverage will be offered to each of the qualified beneficiaries. Each
qualified beneficiary will have an independent right to elect COBRA continuation
coverage. Covered employees may elect COBRA continuation coverage on behalf of
their spouses, and parents may elect COBRA continuation coverage on behalf of their
children.
COBRA continuation coverage is a temporary continuation of coverage that generally
lasts for 18 months due to employment termination or reduction of hours of work.
Certain qualifying events, or a second qualifying event during the initial period of
coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage
can be extended:
The parent-employee dies;
The parent-employee’s hours of employment are reduced;
The parent-employee’s employment ends for any reason other than his or
her gross misconduct;
The parent-employee becomes entitled to Medicare benefits (Part A, Part B,
or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the Plan as a “dependent
child.”
2
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security
to be disabled and you notify CVT in writing in a timely fashion, you and your entire
family may be entitled to get up to an additional 11 months of COBRA continuation
coverage, for a maximum of 29 months. The disability would have to have started at
some time before the 60th day of COBRA continuation coverage and must last at least
until the end of the 18-month period of COBRA continuation coverage.
3
Second qualifying event extension of 18-month period of continuation coverage
“To protect your
family’s rights, let
CVT know about
any changes in the
addresses of family
members “
If your family experiences another qualifying event during the 18 months of COBRA
continuation coverage, the spouse and dependent children in your family can get up to
18 additional months of COBRA continuation coverage, for a maximum of 36 months, if
CVT is properly notified in writing about the second qualifying event. This extension may
be available to the spouse and any dependent children getting COBRA continuation
coverage if the employee or former employee dies; becomes entitled to Medicare
benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the
dependent child stops being eligible under the Plan as a dependent child. This extension
is only available if the second qualifying event would have caused the spouse or
dependent child to lose coverage under the Plan had the first qualifying event not
occurred.
Are there other coverage options besides COBRA Continuation
Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage
options for you and your family through the Health Insurance Marketplace, Medicaid, or
other group health plan coverage options (such as a spouse’s plan) through what is called
a “special enrollment period.” Some of these options may cost less than COBRA
continuation coverage. You can learn more about many of these options at
www.healthcare.gov.
“This notice
If you have questions
explains COBRA
Questions concerning your Plan or your COBRA continuation coverage rights should be
addressed to the contact or contacts identified below. For more information about your
rights under the Public Health Services Act (PHSA) contact the Department of Health and
Human Services in your area or visit www.healthcare.gov/unemployed/cobra-coverage.
For more information about the Marketplace, visit www.HealthCare.gov.
Keep your Plan informed of address changes
PHONE: 559.437.2960
FA X : 5 5 9 . 4 3 7 . 2 9 6 5
A D D R E S S : P. O . B o x 2 6 3 0 0
F r e s n o , C A 9 3 7 2 9
To protect your family’s rights, let CVT know about any changes in the addresses of family
members by emailing CVT at [email protected]. You should also keep a copy,
for your records, of any notices you send to CVT.
W E B S I T E : w w w. c v t r u s t . o r g
EMAIL: [email protected]
Plan contact information
California’s Valued Trust (CVT)
P.O. Box 26300
Follow us on Facebook!
Continuation
Coverage Rights
Under COBRA
Fresno, CA 93729-6300
559-437-2960
4
continuation
coverage, when it
may become
available to you and
your family, and
what you need to do
to protect your right
to get it. “
Introduction
You’re getting this notice because you recently gained coverage under a group
health plan (the Plan). This notice has important information about your right to
COBRA continuation coverage, which is a temporary extension of coverage under
the Plan. This notice explains COBRA continuation coverage, when it may
become available to you and your family, and what you need to do to protect
your right to get it. When you become eligible for COBRA, you may also become
eligible for other coverage options that may cost less than COBRA continuation
coverage.
The right to COBRA continuation coverage was created by a federal law, the
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA
continuation coverage can become available to you and other members of your
family when group health coverage would otherwise end. For more information
about your rights and obligations under the Plan and under federal law, you should
review the Plan’s Summary Plan Description at www.cvtrust.org/plan-documents or
call California’s Valued Trust (CVT) at 1-800-288-9870.
You may have other options available to you when you lose group health
coverage. For example, you may be eligible to buy an individual plan through the
Health Insurance Marketplace. By enrolling in coverage through the Marketplace,
you may qualify for lower costs on your monthly premiums and lower out-of-pocket
costs. Additionally, you may qualify for a 30-day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if
that plan generally doesn’t accept late enrollees.
1